VISUAL FIELDS EXAMINATION

Introduc)on, consent and hand-washing.

Explain to the pa)ent that you are going to examine their field of vision or “side vision”.

Sit approx 1m opposite pa)ent - approximately an arm’s length.

Check for gross field defect, both eyes open

• Monocular central vision: Ask pa)ent to cover one eye, ask if they can see your face, “Is any
part of my face missing?” Then repeat for the other eye.

• Binocular peripheral vision: Bring both hands up, ask pa)ent to point at which hand is
moving.

Now check for monocular peripheral field defect.

• Ask pa)ent to close one eye (eg right eye). You close your leP eye.

• Hold up target (white pin/finger) in each quadrant and ask pa)ent if can see it.

• Check visual field by moving target coming from seen to unseen – ask pa)ent to iden)fy
when they no longer see the target.

• Compare to your own normal field.

Important visual field defects

1. Complete right op)c nerve lesion – no vision in right eye

Causes: Re)nal artery occlusion, trauma)c or compressive op)c neuropathy, extensive

re)nal detachment.

2. Op)c chiasm lesion – Bitemporal hemianopia

Causes: Chiasmal lesions eg. pituitary adenoma, meningioma, craniopharyngioma,

aneurysm, glioma.

3. Op)c tract lesion – Homonymous hemianopia

Causes: Space occupying lesions, stroke, aneurysm, trauma, migraine

4. Lesion in temporal op)c radia)on (Meyer’s loop) – superior quadrantanopia “pie in the sky”

Causes: Space occupying lesions, stroke, aneurysm, trauma, migraine

5. Lesion in parietal op)c radia)on (Baum’s loop) – inferior quadrantanopia "pie on the floor"

Causes: Space occupying lesions, stroke, aneurysm, trauma, migraine